Ponkesdes - Telempong 2023 10 01 2023 10 31

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<td height="34" width="38" rowspan="2"
style='height:25.50pt;width:28.50pt;'>No.</td>
<td align="center" width="88" rowspan="2" style='width:66.00pt;'>No.
Bpjs</td>
<td align="center" width="93" rowspan="2"
style='width:69.75pt;'>Tangal</td>
<td align="center" width="305" rowspan="2" style='width:228.75pt;'>Nama</td>
<td align="center" rowspan="2">JK</td>
<td align="center" width="305" rowspan="2" style='width:228.75pt;'>Alamat</td>
<td align="center" width="150" rowspan="2" style='width:112.50pt;'>No.
Kartu Peserta</td>
<td align="center" width="150" rowspan="2" style='width:112.50pt;'>Jenis</td>
<td align="center" width="565" colspan="9"
style='width:423.75pt;'>Pelayanan</td>
<td align="center" width="88" rowspan="2" style='width:66.00pt;'>Diagnosa</td>
<td align="center" width="200" rowspan="2" style='width:200.00pt;'>Terapi</td>
<td align="center" width="88" rowspan="2" style='width:66.00pt;'>BB/TB</td>
<td align="center" width="88" rowspan="2" style='width:66.00pt;'>TD</td>
<td align="center" width="88" rowspan="2" style='width:66.00pt;'>HR</td>
<td align="center" width="88" rowspan="2" style='width:66.00pt;'>RR</td>
<td align="center" width="88" rowspan="2" style='width:66.00pt;'>TTD</td>
<td align="center" width="88" rowspan="2"
style='width:66.00pt;'>STATUS</td>
</tr>
<td align="center">Umum (BP)</td>
<td align="center">Gigi</td>
<td align="center">KIA</td>
<td align="center">Kebid.</td>
<td align="center">KB</td>
<td align="center">UGD</td>
<td align="center">Jiwa</td>
<td align="center">Rujukan</td>
<td align="center">Kunj. Sehat</td>
</tr>
<td height="17" align="right">1.</td>
<td align="center">1</td>
<td class="xl67" align="center" > 23/10/2023</td>
<td>BUHARI</td>
<td>L</td>
<td>KRAJAN TELEMPONG</td>
<td align="center"> 0000707276428</td>
<td align="center">PBI (APBN)</td>
<td align="center"></td>
<td align="center">✔</td>
<td>Z00</td>
<td></td>
<td align="center">50/165</td>
<td align="center">DILAYANI</td>
</tr>
<td>SELFI NURUYANTI</td>
<td>P</td>
<td>BUNGUR TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>PURWANTO</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUPYO</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUMIATI</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUDARSONO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>ADIYONO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISNADI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISRANI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MARYONO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MARSAM</td>
<td>L</td>
<td align="center">KEPALA DESA DAN PERANGKAT DESA</td>
<td>Z00</td>
<td></td>
</tr>
<td>MANINTI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>NUR HASANAH</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ANGGI PURWANTO</td>
<td>L</td>
<td>TELEMPONG</td>
<td align="center">PEGAWAI SWASTA</td>
<td>Z00</td>
<td></td>
</tr>
<td>DWI HARTONO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SADEN</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>IYA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUHARNO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>NARTI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>JUBRIYADI</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>ARNI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MARTINA</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>SURATI</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>WAHYUNINGSIH</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUKAR</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUKARMAN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUTIK</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MUJARI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>NUR AZIZAH</td>
<td>P</td>
<td>Kp.krajan rt/rw: 002/001 telempong</td>
<td>Z00</td>
<td></td>
</tr>
<td>NURADEN</td>
<td>L</td>
<td>Krajan - telempong </td>
<td>Z00</td>
<td></td>
</tr>
<td>HAMID UMAR</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>ADAM YONO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>EDY SURYANTO</td>
<td>L</td>
<td>BUNGUR - TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>JURANG PENATAS SUNARI</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>ASDI</td>
<td>L</td>
<td align="center">PNS PUSAT</td>
<td>Z00</td>
<td></td>
</tr>
<td>SALMA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ASGA ASTUTIK</td>
<td>P</td>
<td>BUNGUR - TELEMPONG</td>
<td align="center">PNS DAERAH</td>
<td>Z00</td>
<td></td>
</tr>
<td>LIONO</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>WASIR</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>FAUZAH</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISARI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ISPA TITIN</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MERNIA DEWI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SHELATUL JANNAH</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUPIATUN</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MARSIANA</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>JUMALI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUAMI</td>
<td>P</td>
<td>BUNGUR</td>
<td>Z00</td>
<td></td>
</tr>
<td>ARBITO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>BUYARI ARBIYA</td>
<td>P</td>
<td>bungur</td>
<td>Z00</td>
<td></td>
</tr>
<td>RAISA DWI N.</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SITI RAHMATILLAH</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>HARTONO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>BUDIANTO</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUMARMI</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUDILI</td>
<td>L</td>
<td>bungur</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISNATI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>JUKAR</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUTRISNO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>NANANG R</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>HIDAYATULLAH</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MERLINDA KHAIRUNNISA'</td>
<td>P</td>
<td>DUSUN KRAJAN 002/OO1 - TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>ABDUL HALIL</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>RODHIYAH</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>AHMAD DEVA ROHALI SAPUTRA</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>HUSNUL HOTIMAH</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>NOR</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISYA</td>
<td>P</td>
<td>KRAJAN BANYUGLUGUR</td>
<td>Z00</td>
<td></td>
</tr>
<td>NIKA</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>NUR FAIDAH TUSLINI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>PARDI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>P.HALIK</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>ABDUR RAHMAN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>HERMANTO</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>TOMAS AMEREKO</td>
<td>L</td>
<td>KP BUNGUR RT05 RW02 TELEMPONG BANYUGLUGUR</td>
<td>Z00</td>
<td></td>
</tr>
<td>SRI WAHYUNI</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>UMI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>TORIYA/ KEROK</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>HANAMI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>FATIMA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SODJO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>FARIDATUL HIDAYATI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>P. DAUD / RENE</td>
<td>L</td>
<td>KRAJAN</td>
<td>Z00</td>
<td></td>
</tr>
<td>ABDUL KADIR</td>
<td>L</td>
<td>KRAJAN 001/001 TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>P.MADEN</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>INDRAYATUN</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>DEWI NURMISTIN</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MUHAMMAD TASREP</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>P. MUSKI / SUNAJIB</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUSY AFRIYANTI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ASMINA</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>YUNITA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>P.SARDIN</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUNATI</td>
<td>P</td>
<td>KRAJAN</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUDIYONO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUJA'I</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>JAMALUDIN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>KANTI ARUM SAFITRI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SITI UMROH ATUL AZIZAH</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SITI MUZAROFAH</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>SAMI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>HAFID</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SANIMAN</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>RUSTI</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>SIALWI</td>
<td>P</td>
<td>KRAJAN</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUMINA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISJOKO</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>MANIRA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUYANI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MAI</td>
<td>P</td>
<td>KRAJAN</td>
<td>Z00</td>
<td></td>
</tr>
<td>SURO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>GANIS H</td>
<td>L</td>
<td>BUNGUR</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUPIYA</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>JUANTO</td>
<td>L</td>
<td>KRAJAN</td>
<td>Z00</td>
<td></td>
</tr>
<td>YAYUK YULIANA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>CHOIRUL ANAM</td>
<td>L</td>
<td>KP.BUNGUR 003/002</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISYA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ARYANI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUNARJO</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>MOH.UBAIDILLAH</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>FARIS</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MARSIYO</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>snewi</td>
<td>L</td>
<td>Bungie, desa telempong</td>
<td>Z00</td>
<td></td>
</tr>
<td>NITI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>LAMIDIYANTO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MATRA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MIRUN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUWARSI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>GITA PAMUJI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>KAMELIA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>EKO SAIFUL KUSMITO</td>
<td>L</td>
<td>KP. KRAJAN RT/RW:002/001 TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>ARYADI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUNAIDI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISTI</td>
<td>P</td>
<td>BUNGUR</td>
<td>Z00</td>
<td></td>
</tr>
<td>SENAWATI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MUNI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SADIN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUSANTI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>B SAIMA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUMIATI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>HARSONO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>AGUS T</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MARGITO</td>
<td>L</td>
<td>telempong</td>
<td>Z00</td>
<td></td>
</tr>
<td>ASNIYA</td>
<td>P</td>
<td>KRAJAN</td>
<td>Z00</td>
<td></td>
</tr>
<td>AGUS</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUWARNI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SAIFULLAH</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>ALEX SAMSUDIN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>BUSARAM</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>AIDIL AMAR</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>KHUSNUL KHOTIMAH</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ALVANI NURUL LAILA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SOFIATUN NAINI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>LUSIANI</td>
<td>P</td>
<td>KRAJAN RT/RW: 004/001 TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUSIATI</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>JUMA'IYA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>LELY HERAWATI</td>
<td>P</td>
<td>BUNGUR, TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>AYAT</td>
<td>L</td>
<td>krajan</td>
<td>Z00</td>
<td></td>
</tr>
<td>HANA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUKARNI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>YUANA YUDI ASTUTIK</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>SATIANI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>NIRO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>ISMAIL</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUMARNI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SANUJI</td>
<td>L</td>
<td>BUNGUR 002/002</td>
<td>Z00</td>
<td></td>
</tr>
<td>DANANG APRIANTORO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MULYA</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>NORTI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>Mut Baena</td>
<td>P</td>
<td>Bungur</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUGIK</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>NIPA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>asdam</td>
<td>L</td>
<td>telempong</td>
<td>Z00</td>
<td></td>
</tr>
<td>HANDIAN SYAH</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>NURADIN</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>ARJI</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>MADRUS</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>NIYEM</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SANI WIJAYANTI</td>
<td>P</td>
<td>BUNGUR</td>
<td>Z00</td>
<td></td>
</tr>
<td>LIMANTO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>HUMMA</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUGIHARTINI</td>
<td>P</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>ATMOJO</td>
<td>L</td>
<td>DUSUN BUNGUR</td>
<td>Z00</td>
<td></td>
</tr>
<td>TOYANI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ANWARI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SENA NINGSIH</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>BURO</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>AMIRUL HIDAYAH</td>
<td>L</td>
<td>TELEMPONG</td>
<td>Z00</td>
<td></td>
</tr>
<td>SANTOSO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUTIKNO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td align="center">A27</td>
<td>SAHAB</td>
<td>L</td>
<td>M79.1</td>
<td></td>
</tr>
<td>TOYANI</td>
<td>P</td>
<td>M79.1</td>
<td></td>
</tr>
<td>RAHMAT ULUM</td>
<td>L</td>
<td>M79.1</td>
<td></td>
</tr>
<td>SURYANI</td>
<td>P</td>
<td>I10</td>
<td></td>
</tr>
<td>SUMARNI</td>
<td>P</td>
<td>K29.7</td>
<td></td>
</tr>
</table>
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